目的：检测内脂素在稽留流产（missed abortion,MA）及正常早孕人工流产（人流）孕妇血浆中的浓度和胎盘绒毛组织中的表达情况,探讨其在MA发生机制中的作用。方法：将2016年10月至2017年4月间在上海交通大学附属国际和平妇幼保健院因MA住院刮宫和非意愿妊娠在门诊作早孕人流的病例分别列为MA组（36例,孕5~11周）和正常早孕对照组（20例,孕5~11周）,采用酶联免疫吸附双抗体夹心法及免疫组织化学法（免疫组化）检测其血浆内脂素浓度和胎盘组织中内脂素的表达。结果：MA组的血浆内脂素浓度为（55.98±10.30） ng/mL,对照组的血浆内脂素浓度为（70.19±11.70 ） ng/mL,2组间差异有统计学意义（P<0.001）;免疫组化评分也证实,MA患者胎盘绒毛组织中的内脂素表达量明显低于对照组,差异有统计学意义（P<0.001）,且在血浆中的内脂素浓度与胎盘绒毛组织中内脂素的表达量间具有显著的相关性（r=0.711,P<0.01）;MA组胎盘绒毛组织退变发生率（94.4%）高于对照组,血浆内脂素浓度低、胎盘组织内脂素低表达与胎盘绒毛组织退变发生率间具有相关性（r=-0.684,P<0.001;r=-0.404,P=0.002）。结论：内脂素在血浆及胎盘绒毛组织中的低表达可能是导致MA的原因之一;检测血浆中内脂素浓度可作为监测妊娠进展的指标之一。
Objective: To detect and compare the plasma level and expression of visfatin in placental tissue of missed abortion (MA) and induced abortion of unwanted normal pregnancy for exploring the possible role of visfatin in the pathogenesis of MA. Method: A total of 36 cases of MA (5-11 gestational weeks) and 20 cases of induced abortion of unwanted normal pregnancy (5-11 gestational weeks) were collected in the International Peace Maternal and Child Health Hospital affiliated to Shanghai Jiao Tong University between October, 2016 to April 2017. The double antibody enzyme-linked immunosorbent assay (ELISA) and immunohistochemical method (IHC) were used to detect visfatin level in plasma and expression of visfatin in placenta tissue. Result: By ELISA, the plasma level of visfatin in MA patients was (55.98±10.30) ng/mL and the plasma level of visfatin in induced abortion of unwanted normal pregnancy group was(70.19±11.70) ng/mL, the difference was statistically significant(P<0.001). By IHC, the expression of visfatin in placenta tissue was significantly lower in MA patients than in induced abortion of unwanted normal pregnancy group (P<0.001). Moreover, there was a significant correlation between the plasma level and placenta expression of visfatin (r=0.711, P<0.01). The degeneration rate of placental villus in MA group was higher than that in induced abortion of unwanted normal pregnancy group, and the low expression of visfatin was correlated with placental villus degeneration rate (r=-0684, P<0.001), and this correlation was more obvious than that between level of plasma visfatin and placental villus degeneration. Conclusions: The low expression of visfatin in plasma and placenta tissues may be involved in the pathogenesis of MA. Determining plasma visfatin level may be used as one of the indicators for monitoring the progress of pregnancy.
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